Laparascopic suturing device and suture needles

ABSTRACT

A surgical suturing tool comprising a suture needle holder and suture needle is disclosed. The needle includes a groove in its sidewall which leads to a blind hole to receive one end of a suture which is secured therein by swedging.

This is a continuation of co-pending application Ser. No. 08/388.690,filed on Feb. 15, 1995.

FIELD OF THE INVENTION

This invention is in the field of laparascopic suturing devices andsuturing needles used therewith, and surgical techniques for closure oftrochar holes and other openings and wounds particularly in abdominalsurgery.

BACKGROUND OF THE INVENTION

In laparascopic surgery a known device called Deep Suture is a needleholder made by REMA® Medizintechnik GmbH of Germany, D-7201Durbheim-Tuttlingen, In Breiten 10 Germany. It is believed that a Germanpatent corresponding to this device is DE 42 10 724 C1, a copy of whichin German is attached hereto as Appendix A and incorporated herein byreference.

While this device has various inherently good features, a number ofsignificant improvements have been developed as disclosed in thisapplication. The prior device, in summary, has a central shaft withproximal and distal ends. Extending through the shaft is a rotatable rodhaving a control handle at the proximal end and a drive gear at thedistal end. A pair of driven gears are positioned at the periphery ofthe drive gear at opposite sides thereof, each driven gear coupled to anarm or wing that pivots radially outward from the shaft when the controlhandle is turned. Each wing includes a recess or blind hole forreceiving the proximal end of a suture needle. In operation a singlestrand of suture material has its ends threaded through the eye of eachof the needles, the suture then extending as a double strand from eachneedle. The proximal ends of the needles are then inserted in the wings,and the wings are pivoted to their retracted position whereby they andthe needles are radially inward of the outer cylindrical boundaryestablished by the central shaft. To facilitate this an axial groove isprovided in the shaft into which each needle can move. The device, withwings retracted, is inserted down into the opening in the abdominal wallproduced by a trocar. During insertion the suture is dragged down.

When adequately inserted downward the wings are pivoted to open positionexposing the needles now pointing upward. The shaft is withdrawn untilthe needles pierce the wall and protrude out of the wall. These needlesare engaged individually by a clamp, forceps or a needle holder or by aclamping device movable axially on the shaft and drawn through thetissue, pulling the suture until it forms a loop beneath the opening.The wings, now empty of needles, are pivoted closed, and the shaft isextracted from the opening. The needles are cut off the suture ends andthe suture is tied.

The improvements in this device are described below.

SUMMARY OF THE NEW INVENTION

During the procedure described above the needles may become dislodgedand separate from the wings. The new invention provides in combinationan improved needle and improved insertion device with a groove in thedistal end of the central shaft. Each needle has a groove in its sidewall to receive one end of the suture which is secured therein, as byswedging. The grooves in the needles are preferably inclined downward.The suture exits the groove oriented angularly downward toward theproximal end of the needle which is also in the direction toward thewing and toward the distal end of the central shaft.

In operation the needles are situated with their proximal ends in theblind holes in the wings and the suture line extending from each needleis drawn downward to lie in the groove. The remainder of the sutureextends upward toward the handle and is held and guided by the operator.By pulling upward on said remainder of the suture (which extends as acontinuous strand between the needles), the needles are pulled downwardto remain securely seated in the wings. The needles are urged downwardbecause the groove through which the suture is pulled lies further belowthe wings than the lower ends of the needles.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an exploded elevation of the new device and the new needles.

FIG. 2A is an elevation of the new device, and

FIGS. 2B, 2C, and 2D are fragmentary elevations of the distal end of thedevice at different stages.

FIG. 3 is a fragmentary elevation partially cut away showing the drivemechanism.

FIG. 4 is a sectional view taken along line 4--4 in FIG. 3, with thewings closed.

FIG. 5 is a sectional view similar to FIG. 4 with the wings open.

FIG. 6 is fragmentary section view of the new needle

FIGS. 7 and 8 are fragmentary front and side views of the needle of FIG.6.

FIG. 9 is a fragmentary front view shown schematically of a needle witha groove swedged closed capturing the end of a suture.

FIG. 10 is a schematic view of the new device when inserted and thewings are open.

FIG. 11 is a schematic view similar to FIG. 10.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

FIG. 1 shows a first embodiment 10 of the new suturing device includingthe central shaft 12 with proximal end 13 and distal end 14. At theproximal end is handle 15 and control knob 16. At the distal end arewings 17, grooves or channels 18 corresponding in length to the needlesto receive the needles and guide notch 19. In handle 15 is a cleaningport 20. Along the length of shaft 12 is a depth gage 21. Also shown areneedles 21 and suture 22 positioned for insertion into blind holes 23 inthe wings.

FIG. 2A shows device 10 oriented upside down relative to FIG. 1, withthe wings 17 in fully closed condition; FIG. 2B shows the distal end 19of the device with the wings partially open; FIG. 2C shows the distalend with the wings fully open; and FIG. 2D shows the distal end with thesuture 22 lying in groove 19.

FIGS. 3 and 4 show a typical drive mechanism 30 for the new device, thecomponents thereof corresponding generally to the device of FIGS. 1 and2A. In FIGS. 3 and 4 the shaft 31 has a distal end 34 with the sutureguide groove 36 shown in dotted line. Through shaft 31 is drive rod 32coupled to drive gear 41 which is further coupled to driven gears 39,each of which is secured to a wing 37. Needles 42 are removably situatedin blind holes 38 in the wings. The wings in closed position aredesignated by 37' in FIG. 3 along with needles 42' in closed position.Driven gears 39 revolve on pivots 40.

Rotation of control knob (not shown) rotates rod 32 and drive gear 41.This causes driven gears 37 to pivot radially outward carrying needles42 to their open position.

FIGS. 6-16 show a new needle 45 with its groove 46 and end 47 of suture48 swedged therein. The groove 46 may extend to various depths or as ablind hole for receiving the end of the suture. The groove and/or holemay be formed by cutting, lancing, forging or other techniques.

Securing the suture end to the needle is thereafter done by swedging,peening or otherwise deforming the metal of the needle adjacent thesuture to achieve a clamping action on the suture. Other adheringtechniques may be used, but ideally the suture extends from the needlewith substantially little added thickness or effective diameter of theneedle.

The groove is oriented to lead the suture out of the side surface of theneedle at an angle downward toward the proximal end of the needle,opposite the point. The angle of exit is preferably small, as between 1°and 20°. The exit of the groove or the point of exit from the sidesurface of the needle is near the proximal end or closer to that endthan the point.

Thus, when the needle is seated in the hole in a wing, pulling on thesuture will apply a force tending to keep the needle well-seated down inthe hole in the wing, particularly during the suturing procedure.

The use of a groove and/or blind hole allows the suture to exit at thedownward angle and thus avoid the double thickness of suture if thetraditional suture "threaded" through the eye at a general 90° angletherefrom which creates highly undesirable drag as the needle is pulledthrough the abdominal wall.

The new device and new needles herein described may be used for closingtrochar holes not only in abdominal walls, but in thoracic walls andother deep or difficult to reach areas.

A further feature of this invention is a cleaning port and Luer fittingsituated in the handle. When opened the port allows high pressurecleaning solution from a syringe or other source to flow down thecentral aperture containing the drive rod and to the gears and wings.

FIG. 10 shows schematically the suturing device 50 inserted through heabdominal wall 51, with the wings 52 open and needles 53 and 54positioned for penetration of the wall. Suture ends 55 and 56 extendfrom needles 53 and 54 respectively in a downward direction of arrows 57through guide notch 19 and thence upward. In practice the segments 58,59 of the suture as seen in FIG. 11 are pulled together and upward alongthe shaft to be held by the surgeon's finger in order to maintain securedownward tension on segments 60 and 61 and thus to apply constantdownward seating force on the needles in the wings.

The insertion device is made of stainless steel or equivalent, with aplastic handle or as available from REMA® referred to above. Sutureneedles are made pursuant to standard commercial practice as typicallymade by Surgical Specialties Corp., P.O. Box 310, Reading, Pa. 19607,also called Sharpoint®, one embodiment being 0.0505 diameter, taperpoint 1-0 polypropylene or catgut suture 20" double armed. Teaching forneedles and sutures may be seen in U.S. Pat. No. 3,799,169 which isincorporated herein by reference and a copy is attached hereto asAppendix B. For the invention herein a suture length of 40-100 cm wouldbe used, one specific preference being 60 cm. Also with this inventionneedle length would be in the range of about 3-10 cm. A great variety ofcommercially available suture material may be selected as determined bythe surgeon and the procedure.

Various other structures and arrangements besides those depicted hereinare possible within the spirit and scope of this invention and as setforth in the claims appended hereto.

I claim:
 1. A surgical suturing tool, comprising:a) a suture needlecomprising an elongated essentially straight shaft which traverses anessentially linear path of travel and having a first end tapered to apoint, a second end, and a medial portion between the first end andsecond end, said medial portion having an axially aligned groove leadingto a blind hole into which a surgical suture can be fixedly secured,said groove oriented to lead the surgical suture out of a side surfaceof the suture needle at an angle downward toward the proximal end of theneedle opposite the point; and b) a suture needle holder comprising:anelongated tube having a proximal end and a distal end and having anouter wall extending there between enclosing an internal cavity; thedistal end having a rounded surface with an external groove ofsufficient depth to retain a suture therein; a pair of wings adjacentthe distal end, each wing being pivotable from within the tube at afirst end and having a second end which is radially extensible, thesecond end of said wing having a blind hole for removably receiving saidsuture needle in said blind hole, said needle being alignedsubstantially parallel with said elongated tube; a control elementmounted on the proximal end of the tube, operatively connected to saidpair of wings for pivoting purposes; and the tube further including aflushing port mounted near the proximal end, said flushing port being influid communication with the distal end.
 2. The surgical suturing toolof claim 1 wherein said wings are movably stored in a pair of matingrecesses in the tube by said control element to simultaneously rotatethe wings, the wings being rotatable inwardly into a closed positionwhich does not extend beyond the outer wall of the tube and to an openposition extending radially outwardly from the tube.
 3. The surgicalsuturing tool of claim 2 wherein said control element is a rotatableknob centrally located at the proximal end of said tube.
 4. The surgicalsuturing tool of claim 3 wherein said distal end comprises an end cap,said end cap being rounded and grooved for receiving said suture.
 5. Thesurgical suturing tool of claim 4 wherein said grooved end cap liesadjacent the wings.
 6. The surgical suturing tool of claim 2 where saidsuture needle holder further includes a handle mounted on the proximalend of the tube, said handle extending radially outward of the tube. 7.The surgical suturing tool of claim 1 wherein each of said wings carriesa needle-suture combination wherein said suture is fixedly securedwithin said needle blind hole for fixedly securing said suture.
 8. Amethod for surgically suturing a wound, comprising the stepsof:fastening two swaged suture needles to blind holes in wings of asuture needle holder such that said needles will follow an essentiallylinear path of travel; attaching a suture to a blind hole along a sideof each needle, said blind hole having a groove leading thereto, saidgroove oriented to lead the surgical suture out of a side surface ofeach suture needle at an angle downward toward a proximal end of eachneedle opposite the point of each needle; placing the suture within asuture retaining groove; tensioning the suture; inserting the sutureneedle holder into a wound to be sutured; extending the suture needleaway from the suture needle holder; withdrawing the suture needle holderoutwardly such that the needle penetrates the tissue to be sutured bythe suture needle; disengaging the suture needle from the suture needleholder; pulling the suture needle and suture through the tissue to besutured substantially parallel to said needle holder; removing thesuture needle holder from the patient, and suturing the patient.
 9. Asurgical suturing tool as in claim 1, wherein said needle is straightand said groove is oriented to provide an angle of exit ranging between1 and 20 degrees.
 10. A method as in claim 8, wherein each said needleis straight and said groove is oriented to provide an angle of exitranging between 1 and 20 degrees.